Contribuições para análise da política de saúde auditiva no Brasil

OBJETIVO: Realizar o levantamento do quantitativo dos procedimentos relacionados à adaptação de aparelho de amplificação sonora individual (AASI) incluídos na Tabela do Sistema Único de Saúde (Tabela SUS). MÉTODOS: Os dados sobre os procedimentos relacionados à adaptação de AASI incluídos na Tabela SUS foram levantados no site www.datasus.gov.br. Após o levantamento desses dados, foi realizada a organização e a análise descritiva da produção dos atendimentos ambulatoriais registrados pelos serviços de saúde auditiva do Brasil, durante o período de novembro de 2004 a julho de 2010. Os dados foram analisados estatisticamente. RESULTADOS: Quanto aos procedimentos relacionados à dispensação de AASI no território nacional no âmbito da saúde auditiva, em 2006, a terapia fonoaudiológica ultrapassou o quantitativo obtido pela adaptação de AASI e, o acompanhamento fonoaudiológico, por sua vez, foi pouco realizado no país. Os AASI com tecnologias B e C vem sendo mais adaptados do que os AASI de tecnologia A e a realização de medida com microfone sonda ou acoplador de 2cc na adaptação dos AASI é pouco realizada em comparação ao ganho funcional. CONCLUSÃO: Houve grandes avanços na atenção ao deficiente auditivo no país, mas é necessário aprimorar o acompanhamento dos usuários de AASI, e revisar procedimentos como medidas com microfone sonda e tecnologias dos AASI.

Magnetic fields and acute lymphoblastic leukemia in children: a systematic review of case-control studies

Leukemia incidence in children has increased worldwide in recent decades, particularly due to the rise in acute lymphoblastic leukemia. Studies have associated exposure to non-ionizing radiation generated by low frequency magnetic fields with childhood leukemia. The current article reviews the case-control studies published on this subject. Of 152 articles tracked in different databases, ten studies from North America, Asia, and Europe met the defined selection criteria, with patients diagnosed from 1960 to 2004. Methodological limitations were observed in these articles, including difficulties with the procedures for assessing exposure. An association may exist between exposure to low frequency magnetic fields and acute lymphoblastic leukemia in children, but this association is weak, preventing the observation of consistency in the findings. Future studies from a wider range of geographic regions should focus on the analysis of acute lymphoblastic leukemia, which is the subtype with the greatest impact on the increasing overall incidence of childhood leukemia.

A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)

Background: Recent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections. Methods: Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures. Results: 18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger's graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported. Conclusion: LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.

Reprocessing and reuse of single-use medical devices used during hemodynamic procedures in Brazil: A widespread and largely overlooked problem

Background. Several medical devices used during hemodynamic procedures, particularly angiographic diagnostic and therapeutic cardiac catheters, are manufactured for single use only. However, reprocessing and reuse of these devices has been reported, to determine the frequency of reuse and reprocessing of single-use medical devices used during hemodynamic procedures in Brazil and to evaluate how reprocessing is performed. Design. National survey, conducted from December 1999 to July 2001. Methods. Most of the institutions affiliated with the Brazilian Society of Hemodynamic and Interventional Cardiology were surveyed by use of a questionnaire sent in the mail. Results. The questionnaire response rate was 50% (119 of 240 institutions). Of the 119 institutions that responded, 116 (97%) reported reuse of single-use devices used during hemodynamic procedures, and only 26 (22%) reported use of a standardized reprocessing protocol. Cleaning, flushing, rinsing, drying, sterilizing and packaging methods varied greatly and were mostly inadequate. Criteria for discarding reused devices varied widely. Of the 119 institutions that responded, 80 (67%) reported having a surveillance system for adverse events associated with the reuse of medical devices, although most of these institutions did not routinely review the data, and only 38 (32%) described a training program for the personnel who reprocessed single-use devices. Conclusions. The reuse of single-use devices used during hemodynamic procedures was very frequent in hospitals in Brazil. Basic guidance on how to reuse and reprocess single-use medical devices is urgently needed, because, despite the lack of studies to support reusing and reprocessing single-use medical devices, such devices are necessary in limited-resource areas in which these practices are current.

Oral health in Brazil - Part II: Dental Specialty Centers (CEOs)

The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers), which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System). Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

Cirurgias odontológicas em usuários de anticoagulantes orais

Em razão do crescimento do número de indivíduos submetidos à terapêutica anticoagulante também nos consultórios odontológicos, realizamos um levantamento retrospectivo de prontuários de pacientes anticoagulados com derivados cumarínicos e uma revisão sobre os protocolos de atendimento, a fim de procurar estabelecer diretrizes para um tratamento cirúrgico-odontológico adequado e seguro. A avaliação do paciente com relação ao seu nível de anticoagulação através do Índice Normatizado Internacional (INR) ou Tempo de Protrombina (TP) e a classificação da amplitude do trauma cirúrgico são fatores importantes a serem avaliados antes do procedimento cirúrgico. Nosso levantamento mostrou que, em 47 cirurgias, sem alteração da medicação sistêmica, apenas um caso apresentou hemorragia pós-operatória, controlada por manobras de hemostasia local. Desse modo, observamos que, dentre os vários protocolos propostos na literatura, a manutenção da terapia anticoagulante, com a utilização de hemostáticos locais se necessário, parece o mais adequado à maioria dos casos cirúrgicos ambulatoriais.

Review of the Brazilian Atlantic Rainforest harvestman Longiperna (Opiliones: Gonyleptidae: Mitobatinae)

Longiperna Roewer, 1929 is revised and new records of distribution are presented for the Brazilian Costal Atlantic Rain Forest (from Rio de Janeiro to Santa Catarina states). The following new synonymies are established: Longiperna concolor (Mello-Leitão, 1923) = L. zonata Mello-Leitão, 1935 and L. heliaca B. Soares, 1942; Longiperna coxalis (Roewer, 1943) = L. areolata B. Soares, 1944; Longiperna insperata (Soares & Soares, 1947) = L. paranensis Soares & Soares, 1947 and L. curitibana Kury, 2003. Two new species are described: Longiperna kuryi sp. nov. (type-locality: Brazil, Rio de Janeiro, Parati); Longiperna trembao sp. nov. (type-locality: Brazil, Minas Gerais, Belo Horizonte).

A systematic review of diapoma (teleostei: characiformes: characidae: stevardiinae: diapomini) with descriptions of two new species from southern Brazil

Diapoma is reviewed and four species are recognized: (1) Diapoma thauma, new species, from streams of the rio Jacuí basin, state of Rio Grande do Sul; (2) D. pyrrhopteryx, new species collected from the rio Canoas and streams flowing into this basin in the states of Rio Grande do Sul and Santa Catarina, Brazil; (3) Diapoma terofali, from streams flowing into rio Uruguay in Uruguay and Rio Grande do Sul, Brazil and streams flowing into rio de la Plata, Argentina; and (4) Diapoma speculiferum, from lowland coastal streams in Rio Grande do Sul, Brazil and Uruguay. Diapoma pyrrhopteryx possess the posteroventral opercular elongation typical of D. speculiferum, type species of the genus, but which is absent in D. thauma and D. terofali. Nonetheless, all the diapomin species have the caudal pouch organ about equally developed in both sexes and the dorsal portion of the pouch opening bordered by a series of 3 to 8 elongated scales, the two derived features that characterize the group. The two previously described species, D. speculiferum and D. terofali, are redescribed. Previous hypotheses of relationships among the diapomin genera Planaltina, Diapoma and Acrobrycon are discussed on the basis of preliminary morphological information. It is proposed that the Diapomini is a monophyletic group. An identification key, information on sexual dimorphism, gonad anatomy, reproductive mode and distribution of the species of Diapoma are provided.

Systematic review and cladistic analysis of the Hernandariinae (Opiliones: Gonyleptidae)

The harvestmen subfamily Hernandariinae is reviewed and a new classification is proposed based on cladistic analysis using 67 morphological characters. The subfamily is composed of six genera and 23 species and occurs in south-southeastern Brazil, Paraguay, and northeastern Argentina. Fourteen new combinations are proposed: Hernandaria armatifrons (Roewer, 1917); H. una (Mello-Leitão, 1927); Acrogonyleptes granulatus (H. Soares, 1966); A. pectinifemur (Soares & Soares, 1947); Acanthogonyleptes alticola (Mello-Leitão, 1922); A. editus (Roewer, 1943); A. fallax (Mello-Leitão, 1932); A. fulvigranulatus (Mello-Leitão, 1922); A. marmoratus (Mello-Leitão, 1940); A. pictus (Piza, 1942); A. singularis (Mello-Leitão, 1935); A. soaresi (Mello-Leitão, 1944); A. variolosus (Mello-Leitão, 1944). Seven synonymies are proposed: Proweyhia Mello-Leitão, 1927 and Metaxundarava Mello-Leitão, 1927 = Hernandaria Sørensen, 1884; Apembolephaenus calcaratus Soares & Soares, 1945 = H. armatifrons (Roewer, 1917); Sphaerobunus Rower, 1917 and Paraproweyhia Soares & Soares, 1947 = Acrogonyleptes Roewer, 1917; Paraproweyhia curitibae Soares & Soares, 1947 = Acrogonyleptes exochus (Mello-Leitão, 1931); and Melloleitaniana curitibae B. Soares, 1943 = Acrogonyleptes spinifrons Roewer, 1917. Three species are revalidated: Acrogonyleptes granulatus (H. Soares, 1966), A. pectinifemur (Soares & Soares, 1947), and A. spinifrons Roewer, 1917. Seven new species are described: Hernandaria sundermannorum sp. nov. (São Paulo State, Brazil), Hernandaria anitagaribaldiae sp. nov. (Santa Catarina State, Brazil), Hernandaria zumbii sp. nov. (Santa Catarina State, Brazil), Hernandaria chicomendesi sp. nov. (Santa Catarina State, Brazil), Acrogonyleptes cheguevarai sp. nov. (Rio Grande do Sul State, Brazil), Pseudotrogulus pagu sp. nov. (São Paulo State, Brazil), Pseudotrogulus trotskyi sp. nov. (Paraná State, Brazil).

Analytical procedures for determining Pb and Sr isotopic compositions in water samples by ID-TIMS

Few articles deal with lead and strontium isotopic analysis of water samples. The aim of this study was to define the chemical procedures for Pb and Sr isotopic analyses of groundwater samples from an urban sedimentary aquifer. Thirty lead and fourteen strontium isotopic analyses were performed to test different analytical procedures. Pb and Sr isotopic ratios as well as Sr concentration did not vary using different chemical procedures. However, the Pb concentrations were very dependent on the different procedures. Therefore, the choice of the best analytical procedure was based on the Pb results, which indicated a higher reproducibility from samples that had been filtered and acidified before the evaporation, had their residues totally dissolved, and were purified by ion chromatography using the Biorad® column. Our results showed no changes in Pb ratios with the storage time.

Learning processes and the neural analysis of conditioning

Classical and operant conditioning principles, such as the behavioral discrepancy-derived assumption that reinforcement always selects antecedent stimulus and response relations, have been studied at the neural level, mainly by observing the strengthening of neuronal responses or synaptic connections. A review of the literature on the neural basis of behavior provided extensive scientific data that indicate a synthesis between the two conditioning processes based mainly on stimulus control in learning tasks. The resulting analysis revealed the following aspects. Dopamine acts as a behavioral discrepancy signal in the midbrain pathway of positive reinforcement, leading toward the nucleus accumbens. Dopamine modulates both types of conditioning in the Aplysia mollusk and in mammals. In vivo and in vitro mollusk preparations show convergence of both types of conditioning in the same motor neuron. Frontal cortical neurons are involved in behavioral discrimination in reversal and extinction procedures, and these neurons preferentially deliver glutamate through conditioned stimulus or discriminative stimulus pathways. Discriminative neural responses can reliably precede operant movements and can also be common to stimuli that share complex symbolic relations. The present article discusses convergent and divergent points between conditioning paradigms at the neural level of analysis to advance our knowledge on reinforcement.

The academic plagiarism and its punishments - a review

Currently there is an increase in the occurrence of plagiarism in varied types of academic texts. Therefore, in agreement with the Brazilian Coordination of Improvement of Higher Education Personnel (CAPES) policies, Brazilian higher education institutions should establish guidelines for the detection and inhibition of academic plagiarism. However, the notion of plagiarism is extremely complex, since the ability of textual construction acquired during education is also developed using others' words. Thus, it is necessary to better know the concept of plagiarism and its implications, as well as the consequences of plagiarism and the punishments that may result from it. Consequently, rules and policies to be established will be better founded in order to address the problem of plagiarism in academic texts in a comprehensive and consistent way, not only to inhibit plagiarism but also to promote education on how is possible to create texts in an original fashion.

High prevalence of drug-resistant tuberculosis and other mycobacteria among HIV-infected patients in Brazil: a systematic review

There is a little-noticed trend involving human immunodeficiency virus (HIV)-infected patients suspected of having tuberculosis: the triple-treatment regimen recommended in Brazil for years has been potentially ineffective in over 30% of the cases. This proportion may be attributable to drug resistance (to at least 1 drug) and/or to infection with non-tuberculous mycobacteria. This evidence was not disclosed in official statistics, but arose from a systematic review of a few regional studies in which the diagnosis was reliably confirmed by mycobacterial culture. This paper clarifies that there has long been ample evidence for the potential benefits of a four-drug regimen for co-infected patients in Brazil and it reinforces the need for determining the species and drug susceptibility in all positive cultures from HIV-positive patients.

Eletrodos modificados por hidróxido de níquel: um estudo de revisão sobre suas propriedades estruturais e eletroquímicas visando suas aplicações em eletrocatálise, eletrocromismo e baterias secundárias

The present review paper describes the main features of nickel hydroxide modified electrodes covering its structural and electrochemical behavior and the newest advances promoted by nanostructured architectures. Important aspects such as synthetic procedures and characterization techniques such as X-Ray diffraction, Raman and Infrared spectroscopy, Electronic Microscopy and many others are detailed herein. The most important aspect concerning nickel hydroxide is related to its great versatility covering different fields in electrochemical-based devices such as batteries, electrocatalytic systems and electrochromic electrodes, the fundamental issues of these devices are also commented. Finally, some of the newest advances achieved in each field by the incorporation of nanomaterials will be shown.

Métodos para fabricação de microeletrodos visando a detecção em microambientes

Analysis at microenvironments, like single cells or in minute volumes (nL), is an area of great interest for analytical and biological sciences. Measurements at these experimental conditions demand analytical tools (microelectrodes) capable of monitoring with rapid response, good resolution and minimal perturbation of the system. The major drawbacks in producing these microscopic electrodes have been largely overcome, principally due to the development of new fabrication methods. In this review, these procedures are described with emphasis to those devoted to the construction of microelectrodes for application in microenvironments. Examples of our efforts to use these devices as effective electrochemical sensors are also addressed.